COPD Flashcards
Delayed and incomplete emptying of the lung during __ is Obstructive disease. COPD is the __ leading COD, its cause be a mixture of ___ __ disease and small airway disease.
1) exhalation
2) fourth
3) parenchymal alveolar
___ is the most common RF for COPD. Inflammation of lung causes small airways to __, chronic inflammation leads to destruction of lung parenchyma, resp. bronchioles, & alveoli. This leads to decreased ___ __.
1) Smoking
2) narrow
3) lung recoil
Also watch for recurrent LOWER resp. tract infections, other air pollution, & family hx of COPD as a RF
The 6 COPD diseases we discuss are…
CF
Chronic Bronchitis
Emphysema
Asthma
Bronchiectasis
COPD (Nitric oxide synthase)
Signs of lung HYPERinflation include __ of shld girdle, horizontal ribs, ___-shaped thorax, __/__ diaphragm.
1) elevation
2) barrel
3&4) low/flattened
Due to COPD leading to abnormal gas exchange, your ___ __ __ values will be abnormal. Other dx testing used to indicate COPD are PFTs, CXR, __-__ posture, and aucultations (prolonged __).
1) arterial blood gas (ABG)
2) fwd-leaning posture
3) expiration
3 main symptoms for COPD are coughing, dyspnea, & SOB. Dyspnea is __ overtime, worse with __, & (persistent/intermittent). Cough will be chronic with a recurrent (what cough sound?). Cough may be (persistent/intermittent) and NONproductive. However, any pattern of chronic ___ __ may indicate COPD.
1) progressive
2) exercise
3) persistent
4) wheeze
5) intermittent
6) sputum production
T/F: COPD is associated with smaller total lung capacities (TLCs) and smaller residual volumes (RVs).
FALSE; associated w/ LARGER volumes/capacities
___ is used to quantify the degree of airway obstruction and is the GOLD standard for diagnosing COPD.
Spirometry / PFTs
Normal FEV1/FVC ratio = __
FEV1/FVC ratio indicating COPD = __
Norm = 0.75-0.8 (75-80%)
COPD = < 0.70 (70%)
also FEV1 (Norm=4L) and FVC (Norm=5L) will be decreased
The ___ __ __ __ is a subjective measure that evaluates the severity of breathing difficulty. Another subjective measure that evaluates the impact of COPD on an individual’s life is the __ __.
1) Modified MRC Dyspnea Scale
2) CAT Assessment
The classification for COPD severity has 4 Gold levels. Describe each level.
Gold 1 (mild), FEV1 =/> 80% of predicted
Gold 2 (moderate), FEV1 = 50-80% of predicted
Gold 3 (severe), FEV1 = 30-50% of predicted
Gold 4 (very severe), FEV1 = <30% of predicated
COPD is a progressive disease that gets __ overtime. The ___ Index measures (4). A score of __ to __ is associated w/ a HIGH mortality rate in 52 mo. (13 yrs). End-stage COPD results in __ __.
1) worse
2) BODE index
3) Body mass, Obstruction, Dyspnea, Exercise
4) score of 7 to 10
5) Cor pulmonale (RV failure)
The main goals for tx of Stable COPD are to reduce symptoms and reduce risk. To reduce symptoms, PT should focus on relieving symptoms, improving ___ __, and improving health status. To reduce risk, PT should focus on preventing __ __, preventing & treating __, and reducing mortality.
1) exercise tolerance
2) disease progression
3) exacerbations
Medical management of COPD include meds, vaccinations, tx of sleep disorders, pulmonary rehab/exercise training, and surgical excision of lung vol reduction (LVRS). What is a MODIFIABLE factor that the pt can do to manage COPD?
STOP SHMOKINGGG
(smoking cessation)
Meds to tx COPD include bronchodilators, A1 antitrypsin, & 3 more meds.
1) What are they?
2) What dx is rare for antitrypsin to be used to tx?
1) glucocorticoids, antitussives, O2
2) emphysema
Supplemental O2 is indicated to maintain SaO2 at ___or more for pts w/ arterial __. If pt has Right HF or erythrocytosis & a PaO2 b/w 55 & 60 OR if pt’s PaO2 is <55 or SaO2 <88, this indicates arterial __. Recheck pt’s O2 in 60-90 days to test __ of supplemental O2 if to see if it’s still indicated.
1) 90%
2&3) hypoxemia
4) effectiveness
T/F: According to research, evidence is strong for pulmonary rehab to reduce symptoms (discussed in previous flashcard), reduce S&S of anxiety and depression, & reduce hospitalization among pts with an exacerbation (4wks from prior hosp.).
true
T/F: Research evidence is also strong for tx of COPD with a combo of PT edu, self-management interventions, and integrated care programs.
FALSE; only self-management interventions have strong evidence. Edu ALONE is NOT effective, and integrated care programs show no benefit currently.
Implications for PT tx include strength & endurance training, postural re-edu, __ stretching, edu for recovery from ___ positions, ambulation w/ a __ __, ctrled breathing at __ & w/ __, & ___ __ (think sputum).
1) thoracic
2) SOB
3) RW
4&5) rest & w/ activity
6) secretion clearance
Time to play…NAME THAT DX!!
-Genetic multisystem disorder in kids/young adults affecting organs w/ epithelium (pulmonary & pancreatic).
-Mucus stasis occurs in these conduction organs (i.e. airways, glands, small intestine, pancreas) causing failure of airways to clear mucus normally.
Cystic Fibrosis
T/F: Cystic Fibrosis does not affect salt and water transport, so if the Sweat test shows elevated chloride levels (≥60) then CF is NOT the dx.
False. it causes abnormal transport & elevated levels indicate CF
SALTY BABYYYY
CF results in recurrent lung infiltrates, __ of nutrients, maldigestion & fecal __, failure to thrive w/ __ (oily/fatty stool), & pancreatic insufficiency. Describe the persistent cough that CF can cause one to experience.
1) malabsorption
2) impaction
3) steatorrhea
4) cough become productive with purulent, green sputum
S&S for CF include productive cough/sputum production, incr. temp (low-grade), ___ respiration rate, incr. __ blood cell count, weight/appetite __, & decr. activity levels.
1) incr.
2) white
3) loss
Other than the sweat test, what is a screen for indicating CF in a newborn?
CFTR mutation screen
The goals of medical management of CF include ctrlling lung __, mucus clearance, & improving __ status.
1) infection
2) nutritional
Prognosis of CF has had a dramatic incr. in age of survival. What is a scoring system for CF pts that’s based on chest XR findings? How many categories are on this instrument and how is scoring interpreted?
Brasfield Scoring System:
-Normal/max score = 25, the lower the greater disease severity
-5 Categories
I don’t think he will ask about what the categories are, I think it’s most important for us to know this is base on chest XR and it determines severity of CF
PT Implications for treating CF are.. secretion __ techniques, ctrlled __ techniques, exercise and strength training, __ muscle training, __ stretching exercises, & postural reeducation.
What are 2 things a pt can choose to do that can aid in preventing CF?
1) clearance
2) breathing
3) inspiratory
4) thoracic
5) genetic counseling & screening for CF carrier status
NAME THAT DX!!
-Chronic inflammatory disorder of airways w/
“Episodic” obstruction caused by viral or allergen exposures, exercise, inhalation of cold air.
Hint: greek word for panting
Asthma
S&S of asthma include SOB, chest __, & what type of cough sound?
What are 3 special types of asthma?
1) tightness
2) wheezing
3) seasonal, exercise-induced, & asthmatic bronchitis
Medical management of asthma include emphasis on (short/long) ctrl, identifying/eliminating causes, and meds. PFTs can help evaluate current function, but also measure ___ of obstruction after __ administration.
1) long term ctrl
2) reversibility
3) bronchodilator
PT implications for asthma are similar to the ones for CF except interventions should not begin until what?
Medication regime is established
NAME THAT DX!!
-Characterized by destruction of alveolar walls and enlargement of air spaces distal to terminal bronchiole
-Smoking is a MAJOR CAUSE
Emphysema
T/F: The blue bloater and pink puffer are not accurate & respectful descriptions of pts w/ chronic bronchitis & emphysema, however they are still politically correct descriptions used today.
False; they are NOT politically correct, accurate, or respectful in today’s world
NAME THAT DX!!
-Hypersecretion of mucus begins in large airways and progress to smaller airways
-Chronic productive cough for 3 months/per year for 2 consecutive years
Chronic Bronchitis
Chronic bronchitis S&S include the productive cough, rhonchi/wheezing, and elevated __. What are 2 more S&S (think color & weight)
1) hemoglobin
2) overweight and cyanosis
Emphysema S&S include being underweight, severe __, and a quiet chest. What S&S would be seen on a chest XR?
1) dyspnea
2) hyperinflation of lungs & flattened diaphragm
Bronchiectasis is (chronic/acute) inflammation/infection that causes broncho____ & is (reversible/irreversible).
1) chronic
2) dilation
3) IRREVERSIBLE
Bronchiectasis S&S include cough w/ sputum of ___ secretions composed of think yellow-green plugs. Sputum is greatest at what time of day? Another S&S is __ (bloody cough) and __ & chronic lung infections.
1) micropurulent
2) in the morning
3) hemoptysis
4) recurrent
In addition to auscultations, CT scans, PFTs, & blood work (ABGs), what are 2 more dx tests used to dx Bronchiectasis?
1) sputum testing (for flu & P. aeruginosa)
2) evaluation of gastroesophageal reflux disease
Medical management for bronchiectasis include managing underlying condition & acute exacerbations, long-term management, & the main goal..which is to reduce the # of ___ and improve QoL
exacerbations
Bronchiectasis PT implications are similar to the other dx we’ve discussed but it only consists of __ clearance, __ breathing, and __/__ training
1) secretion clearance
2) ctrlled breathing
3) strength & endurance training
NAME THAT DX!!
___ is the combination disease.
literally this is the only slide/note on this dx in the entire ppt lol
COPD (NOS)
